Socio-Demographic Determinants of Vaccine Coverage For
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International Journal of TROPICAL DISEASE & Health 39(3): 1-13, 2019; Article no.IJTDH.52839 ISSN: 2278–1005, NLM ID: 101632866 Socio-demographic Determinants of Vaccine Coverage for Pneumococcus and Rotavirus among under Five Children in Busolwe Town Council, Butaleja District, Eastern Uganda: A Cross Sectional Study Brenda Wafana Nabwana1, Sylvia Sidney Namayanja1, Collette Kemigisha1, Erina Kisakye1, Amos Kuddiza Kusetula1, Silvester Wakabi1, Ivan Wambi2, Innocent Musiime2, Rebecca Nekaka1 and Yahaya Gavamukulya3* 1Department of Community and Public Health, Faculty of Health Sciences, Busitema University, P.O.Box 1460, Mbale, Uganda. 2Busolwe General Hospital, Butaleja District Local Government, Butaleja District, Uganda. 3Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, Busitema University, P.O.Box 1460, Mbale, Uganda. Authors’ contributions This work was carried out in collaboration among all authors. Authors BWN, SSN, CK, EK, AKK and SW conceived, designed the study, participated in data collection, analysis and manuscript writing. Authors IW and IM supervised the data collection and analysis. Author RN participated in the study conception, design, coordinated the entire COBERS program and reviewed the manuscript. Author YG was a research mentor and supervisor who participated in the study conception, design, preparation for approval and proof reading of the final results and manuscript. All authors read and approved the final version of the manuscript. Article Information DOI: 10.9734/IJTDH/2019/v39i330209 Editor(s): (1) Dr. Thomas I. Nathaniel, Department of Biomedical Sciences, School of Medicine -Greenville, University of South Carolina, Greenville, USA. Reviewers: (1) Giuseppe Gregori, Italy. (2) Indianara Maria Grando, Brazil. Complete Peer review History: http://www.sdiarticle4.com/review-history/52839 Received 28 September 2019 Original Research Article Accepted 03 December 2019 Published 07 December 2019 ABSTRACT Background and Aims: There is a high burden of vaccine-preventable diseases in the children under five years of age, particularly pneumonia diarrhea and which is greatly affected by low immunization coverage despite the existing efforts and policies. This study was carried out in _____________________________________________________________________________________________________ *Corresponding author: Email: [email protected]; Nabwana et al.; IJTDH, 39(3): 1-13, 2019; Article no.IJTDH.52839 Butaleja district and was aimed at establishing the socio-demographic determinants of vaccine coverage for pneumococcus and rotavirus among under five children (U5C) in the district. Study Design: This was a mixed methods cross-sectional study. Place and Duration of Study: Busolwe Town Council, Butaleja District, Eastern Uganda. Methodology: Structured researcher administered questionnaires were administered to 434 caregivers of U5C in different parts of Butaleja district. In-depth interviews with key informants and focused group discussions with Village Health Teams and community members were conducted. Review of Health Management Information Systems records was done. STATA 15 was used to analyze the data. Results: The study found that there is a declining trend in completion of the doses of Pneumococcal vaccine (PCV) and Rotavirus vaccine. For example, in quarter 1 of 2019, out of the 312 children who started immunization, only 2 completed Rota virus immunization and only 117 completed PCV vaccinations a trend that has been observed since 2016. The factors that showed a significant association with the the fact that they gave their child at least one dose of the vaccine were having been sensitized on the current immunisation schedule(P-value = <0.001), misunderstanding that vaccine is harmful for child (P-value = 0.007), willingness to take children to vaccination (P-value = <0.001), and social factors such as family (P-value = <0.030). Gender also played a key determinant role where the children’s fathers lacked knowledge on significance of immunization and thus discouraged the mothers from taking the children for immunization. Inadequate funding was also highlighted from the Focus Group Discussions. Conclusion: Vaccine coverage for pneumococcus and rotavirus is still low in Butaleja district mainly due to the attitudes and perceptions of caregivers as well as the knowledge gap. There is need for extensive sensitization of all community members to enable them understand the significance of immunization. It would further be important to increase the funding of the immunization programme to intensify and ensure effectual outreaches as well as the establishment and enforcement of a policy for immunization compliance. Keywords: Vaccine coverage; Pneumococcus Vaccine (PCV); rotavirus vaccine; under five children (U5C); Butaleja; Eastern Uganda; COBERS; knowledge. ABBREVIATIONS effort, over 24,000 children die of vaccine- preventable diseases every day around the world BUFHS-HDRC : BUFHS Busitema University equivalent to 1 child dying every 3.6 seconds, Faculty of Health Sciences 16-17 children dying every minute, and just about Higher Degrees and Research 9 million children dying every year. In 2008 there Committee was a bigger proportion of deaths in sub- COBERS : Community Based Education, Saharan Africa (4.4 million) and South Asia (2.8 Research and Services million) compared to Latin America, the HMIS : Health Management Caribbean, and industrialized countries (0.1 Information Systems million) [2]. PCV : Pneumococcal Vaccine RHITES-E : Regional Health Integration to Vaccination is key in prevention of some Enhance Services in Eastern infectious diseases as indicated by the reduction Uganda. in incidence rates of invasive pneumococcal U5C : Under Five Children disease were lower after vaccine introduction. It VHTs : Village Health Teams was noted that the incidence rates of pneumococcal invasive disease were 19.0 cases 1. INTRODUCTION per 100,000 for whites, 54.9 for blacks, and 13.7 for other racial groups compared to 2002,where Immunization is the process whereby a person is the incidence rates of pneumococcal invasive made immune or resistant to an infectious disease were 12.1 for whites, 26.5 for blacks, disease, typically by the administration of a and 5.6 for other racial group as obtained from vaccine [1]. The World Health Organization Analysis of data from the Active Bacterial (WHO) launched the Expanded Program for Core Surveillance (ABCs)/Emerging Infections Immunization (EPI) in 1974, and many Program Network, an active, population-based developing countries adopted it. Despite this surveillance system in 7 states. Patients were 15 2 Nabwana et al.; IJTDH, 39(3): 1-13, 2019; Article no.IJTDH.52839 923 persons with invasive pneumococcal should this issue remain unaddressed as disease occurring between January 1, 1998, and evidenced by the current measles outbreaks. December 31, 2002. Furthermore, there seems to be a gap in information and statistics on district specific Additionally, the incidence of Pneumonia is immunization coverage data for some districts. estimated at 0.29 episodes per child which To address this issue awareness is key but for equals 21% of deaths in under five children in this to be achieved, the root cause of this developing countries [3]. Furthermore, the problem should be recognized and the missing prevalence of diarrhea, according to Uganda link or gap can be closed up. It was also Demographic Health Survey (UDHS 2011) done important to assess the standpoint of the by Uganda Bureau of Statistics is estimated at community members to discover why the 23% [4,5]. Busolwe District Hospital records community members did not take their children indicate an increase in the prevalence of both for immunization even when the services were diarrhea and pneumonia despite all efforts to do availed. away with these diseases. Low vaccine coverage has been highly associated to this trend. The aim of this study was therefore to determine the factors associated with vaccine coverage DPT3-Hib3-Heb3 coverage in 2017/18 was at particularly for PCV and Rota Virus vaccine in 95% and measles coverage was 88% in 2016/17 order to provide evidence-based education and and still below the target of 95% in Uganda [5]. sensitization to the community and thus reduce However, the DPT3 coverage showed a decline the prevalence and risks associated with vaccine from 99.2% in 2016/17 [6]. Some districts hesitancy and low immunization coverage in showed a lower than 60 percent measles Butaleja district, Eastern Uganda. coverage for example Nakasongola 59%, Mayuge 58.4%, Apac 58.2%, Bukomansimbi 2. MATERIALS AND METHODS 55.5%, Bulambuli 53.6% and Amudat 53.4% [6]. There seems to be lack of statistical information 2.1 Study Area and Target Population on immunization coverage for some districts and most the information is generalized. The study was carried out in Butaleja District in Eastern Uganda which is bordered by Budaka Low immunization coverage and vaccine and Kibuku districts in the North, Mbale in the hesitancy in Uganda and Butaleja district East, Tororo district in the South East and specifically, has been in existence but has not Namutumba in the West, as shown in Fig. 1 [4]. been solved yet it is set as one of the ten major Butaleja district has a total population of 244153 health threats in 2019 by the World Health people of which 119466 (48.9%) are males and Organization. In a study done in Busolwe aimed 124687 (51.1%) females according to the at determining the knowledge